“It has been a slow start,” said Alisa Ray, executive director and CEO of the Certification Commission for Health Information Technology, of EHR vendors’ readiness for Stage 2 meaningful use. “They’re working hard. They’re struggling a little bit.”

That stands to reason, considering that, when comparing Stage 1 to Stage 2 certification, technology developers are “navigating a higher bar and increased complexity,” she said.

As the end of 2013 closes in, most federal certification bodies are noticing an uptick in the number of vendors who are applying to become certified under the 2014 criteria — the same criteria that will be required for the EHR products providers must use to attest to meaningful use Stage 2.

But not all of them are finding the process to be a cakewalk. Ray said there are three areas of Stage 2 that are proving the most challenging for certification: clinical quality measures, interoperability, and automated measure calculation for reporting metrics.

Automated measure calculation “requires almost a whole day of testing,” she said. “There are just a lot fewer products than were there with the Stage 1 or 2011 criteria.”

CCHIT has close to 40 companies with products listed. “Of the 2011 products we certified, we’ve seen 21 or 22 percent having been completely certified to date,” Ray continued. “It’s a testament to how much harder it is.”

Amit Trivedi, healthcare program manager at ICSA Labs, added that many vendors might also be going through certification fatigue, and explained that in stage 1 there were close to 3,000 listings, and many vendors had multiple entries (Cerner had 800) but for Stage 2, so far there are fewer than 300 on ONC’s Certified Health IT Products List.

And without naming names, Ray said that “almost everyone has struggled and been surprised by the complexities,” and a number of them have had to go through several certification trials, after not meeting certain criteria. “There are companies that have been testing every year since 2006 with the CCHIT programs; it’s not like they’re novices. And when they get into it, there’s a new wrinkle or something they may not have anticipated or configured correctly.”